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Success of Goderich cardiac clinic contradicts LHSC decision

Jane Shackleton is the program director of Healthy Hearts Cardiac Rehabilitation in Goderich. A few of her clients are left to right, George Warner, Ted Vanderwouden Pearl Needham and Linda Brak. (Derek Ruttan/The London Free Press)

Turns out you don’t have to go far to unravel the claims made by those planning to close London’s Cardiac Fitness Institute.

You only have to go to nearby Goderich, where a program inspired by that in London is thriving, its success shown in a recent study.

“(The London cardiac rehab program) should be placed on a pedestal instead of being torn down,” the study’s lead author, Kent Gillen, told The London Free Press.

Published in 2016 in the peer-reviewed Canadian Journal of Rural Medicine, the study found that patients who stay in the Goderich program, called Healthy Hearts, improve long after Ontario cuts off rehab funding at six months, and that the benefits are maintained for nine years.

Nearly a decade after they start cardiac rehab, patients push themselves on a treadmill for 35 per cent longer than they could when they began, efforts that also stabilize blood pressure and resting heart rate.

The benefits weren’t just physical, but emotional and social as well, Gillen said.

The lesson from the research is clear, Gillen told the Canadian Cardiovascular Congress at its annual gathering two years ago — don’t kick out cardiac rehab patients after six weeks or six months, the latter the model adopted by Ontario’s Health Ministry.

“We said don’t do that. Keep them in as long as you can.”

The living testament of his advice is Bill Anderson, a Second World War veteran who turns 96 Tuesday. Anderson suffered his first heart attack about 1990, then had a second several years later.

But after 21 years in the Goderich program, he’s healthy enough to celebrate his birthday this month by travelling to Northern Ontario with three people half his age to do some fly fishing.

“It gave me discipline, routine, supervision and medical oversight,” Anderson said of the program.

“If it were not for Healthy Hearts, I’d probably not be here.”

Similar statements about London’s cardiac institute have been made by many patients, whose anger about its closing has fuelled a backlash — dozens of calls and emails have come in to The Free Press — and denunciations by area opposition MPPs in the Ontario legislature.

The chief executive of the London Health Sciences Centre (LHSC), Dr. Paul Woods, has declined to be interviewed about LHSC’s decision to close the cardiac rehab program that first opened in 1981.

Instead, the hospital poses its own questions and answers on its website.

“Why are you closing the program? As an academic health sciences centre, LHSC adheres to evidence-based decision making when it comes to how patient care is delivered. The decision to wind down the Cardiac Fitness Institute is an outcome of that approach,” hospital officials wrote.

But while London hospital officials claim they made a decision based on evidence and wrote more than 2,000 words defending their decision, the only “evidence” they link is a report on cardiac rehab in Ontario that does not recommend any time frame for rehabilitation.

London officials don’t mention the Goderich study, or one published in June in the peer-reviewed journal of the British Cardiovascular Society that found that those in cardio rehab for more than three years were 60 per cent more likely to be alive 14 years later than those whose rehab ended after one year.

“It’s unfounded,” Gillen said. “We were modelled after the London program. Their data would probably show similar results.”

The Ontario government should stop defending the closing of cardiac rehab at LHSC and instead look to expand that model across the province, he said.

The Goderich program is located at a YMCA and uses donated equipment. Participants are asked to contribute about $50 a month, but that fee is reduced or even eliminated based on the ability to pay.

Those fees cover 80 per cent of the program’s costs while fundraising and sponsorship pays for the rest, said Healthy Hearts program director Jane Shackleton.

The program has proven so popular in the rural Goderich region, that it draws between 100 and 140 new referrals each year.

The costs are tiny compared to the savings as patients avoid future heart surgery and other complications, Gillen said. “(The savings) will be in the millions of dollars,” he said.

In London, the fitness equipment and even the former church where the program has operated were donated to the London hospital, whose yearly tab has typically been between $150,000 and $300,000 out of a budget of $1.2 billion.

Local fundraising has often met or exceeded the hospital spending.

LHSC plans to phase out the cardiac program starting this month over the objections of patients and lead doctor Larry Patrick.

LHSC officials have defended the closing by claiming the best and most recent medical evidence supports a six-month program, which is offered in London through St. Joseph’s Health Care.

The Cardiac Fitness Institute had provided exercise, stress testing and counselling to cardiac patients for as long as they wanted.

In ending the program, LHSC has noted the institute doesn’t fall under the mandate of an acute-care hospital, and that the hospital “receives no funding to support similar services and can no longer subsidize” CFI program costs.